GWooREV.txt Dear Reader, Subject: Second-opinion ODs who help their own children. The majority-opinion is that the minus lens is "perfect", and that anyone who "objects" -- is wrong. Steve Leung will support you with BOTH METHODS. He is a professional -- and you should make your choice before you put your child into a strong minus lens. I PERSONALLY would have liked to be supported by a prevention-minded optometrist like Steve -- who helps his own children with the concept. There is hostility against the PREVENTIVE plus lens. George Woo specifies issues "a" through "l". The response follows his letter to C. Li. This exchange should explain the nature of the "objection" to the use of the plus FOR PREVENTION. Some of the remarks by George are simply false, specifically about Francis Young "participating" in the Houston study. In terms of plus-prevention, the Oakley-Young study strongly supported THAT concept. Make up your mind up accordingly -- before your child's Snellen goes below 20/60, or approximately -1.5 diopters. Sincerely, Otis ==================================== From: George Woo, (Majority-opinion optometrist) To: Mr. Charling Li, Secretary, Optometrists Board 2/F Shun Feng International Center, 182 Queen's Road East Wanchai, Hong Kong Dated: December 17, 2004 Dear Ms. Le, Thank you for inviting me to serve as an expert witness for your Optometrist Board's inquiry. Attached please find a brief resume of mine for your reference. Should you require a detailed copy of my curriculum vitae, please let me know. The questions given to me are as follows: "Whether the statements made by Leung In-hong in the leaflet about the treatment and prevention of myopia, namely the suggestion of using plus lenses to effectively prevent the worsening of myopia and to assist people with myopia in the very early state to recoup their normal vision, can or cannot be substantiated". Having read several documents pertaining to Mr. Steve Leung In-hong's views on his methods of prescribing for myopia, I write to render my opinion. Section "a" Chinese Pamphlet on Myopia (Nearsightedness) Prevention (Appendix 1) Mr. Leung In-hong's statement and claims are misleading and incorrect. He claims that by wearing convex or positive or plus lenses from 1 to 3 years when someone is developing myopia are not based on evidence. In the pamphlet, he does not provide any figures for the amounts of myopia when these positive lenses are prescribed. The message is that concave or negative or minus lenses are detrimental to myopia and only convex or positive or plus lenses should be prescribed for myopia. This is contrary to any conventional treatment for myopia. His statement that 90 % of myopia patients are receiving the wrong treatment is incorrect and misleading. Section "b" Note edited by Leung In-hong, Optometrist (Appendix 2) In a separate note, Mr. Leung In-hong states that the plus lens is a fogging method. According to him, it is the appropriate method to save one's eyesight. He advocates wearing these convex or positive or plus lenses for distant and near viewing. Constant wearing of these lenses is advocated. He also states that for those who have already developed myopia, use of these lenses will stabilize the amount of myopia suggesting that there will be no further increase in myopia. There is no evidence to support his statements. Section "c" Mr. Han Pak-sun's (Alfred's) complimentary statements (Appendix 3) In a table listing his family member's refractive errors, Mr. Han's remarks on them are incomplete and wrong. I assume Mr. Han is a layman and therefore is incapable to describe myopia treatment clearly. However, this information is presumably distributed by Mr. Leung In-hong. Section "d" Dr. Stirling Colgate's letter (Appendix 4) I note that Dr. Stirling Colgate's letter to the National Institute of Medicine was dated November 9, 1977. Young et. al. prospective Houston studies were published in 1985 and 1987 (abstracts attached). Results of the final report by the patient care team are contrary to the beliefs expressed by Colgate. Section "e" Dr. Paul E. Romano's letter (Appendix 5) With the E-address provided by Mr. Leung In-hong, I tried and filed to access the book prefaced by Dr. Romano. Section "f" Dr. David Guyton's letter via e-mail to Miss. Winnie Chong (Appendix 6) It is noted that Dr. Guyton categorically states in his e-mail that, "clearly the plus lenses would not be beneficial for distant vision if the individual is already myopic: they are used for near tasks". Mr. Leung In-hong, on the other hand, is advocating plus lenses for distance and near use. I cannot agree more with Dr. Guyton's advocacy that Mr. Leung should initiate and actual randomized controlled study, over 3 to 5 years, to determine the effectiveness of the method he is using. Section "g" For you information, Edwards et. al. (abstract attached) of Poly U. did conduct a study on the use of progressive lenses (full correction for distance and addition lenses for near). Their study was published in Investigative Ophthalmology and Vision Science (top impact factor journal in Ophthalmology, Optometry and Vision Science) in 2002. Their conclusion is as follows: "The research design used resulted in matched treatment can control groups. There was no evidence that progression of myopia was retarded by wearing progressive addition lenses, either in terms of refractive error or axial length". Section "h" Mr. Leung In-hong's letter to Miss Winnie Chong (Appendix 7) Mr. Leung In-hong cited Dr. Francis Young's statement published in Contacto, a non-citation indexed journal in 1975 to support his belief. Subsequently, Young participated in a prospective Houston study. [Comment by Otis Brown: I must object. Francis Young did NOT participate at all. Documentation about this issue is supplied on this site.] "For the 124 subjects who completed the study, the mean changes in refraction were found to be -0.34 D per year for subjects wearing single vision lenses, -0.36 D per year for those wearing +1.00 D add bifocal, and -0.34 D per year for those wearing +2.00 add bifocals. These differences were not statistically significant." [Comment by Otis Brown: The Oakley-Young study was conducted with +1.5 diopters "add", with the plus highly placed, so the kids could NOT avoid looking THROUGH the plus. The result with 240+ children was that the single-minus group when down by -2 diopters in four years, and the "plus" group when down at a rate of zero diopters per year. This result is HIGHLY SIGNIFICANT. Francis Young did not participate in the Houston study, and did NOT agree with the results -- that contradicted HIS STUDY. At the very minimum, this supports the concept of plus-prevention as the second-opinion.] It should be noted that the Houston study compared bifocal lens wearing children with single-vision leans wearing children with identical amounts of myopia. These single vision lenses are concave or negative or minus lenses. They are not convex or positive or plus lenses advocated for distance and near use by Mr. Leung In-Hong. Section "i" I take exception to Mr. Lung In-hong's statement that USA is far ahead of us by 25 years in vision protection for young people. For your information, Poly U's Myopia Research Center was evaluated by a panel of world renowned experts in myopia research two years ago. I am pleased to inform you that our center ranked 2nd in the world. In the last two International Myopia meetings held in Hong Kong and Guangzhou in 2002 and Cambridge earlier this year, Poly U's presentation on various aspects of myopia has been significant. Section "j" Mr. Leung In-hong cited scientific studies by three Chinese scholars. No reference, however, was given by him. Indeed, none of his references cited by him in his letter, is complete. Section "k" Mr. Leung in his letter states that "if the focal adaptation of eye-sight can be caught at the threshold of the situation -- focal state of zero or slightly negative -- (early myopia), then clear distant vision can be maintained and/or restored by systematic use of plus lenses." In an article published in "vision Research" in 2002 (abstract attached), Chung, et. al. prove under-correction of myopia enhances rather than inhibits myopia progression thus nullifying Leung IN-hong's unsubstantiated arguments. Section "l" It is my professional opinion that Mr. Leung In-houg's statement in the leaflet about the treatment of myopia cannot be substantiated. His method of prescribing treatment for myopia is incorrect and inappropriate. His arguments in the various documents are not convincing and they are not evidence based. Yours sincerely, George Woo, OD, PhD, FAAO Chair Professor of Optometry, Hong Kong Polytechnic University Hong Kong SAR ====================================================== Response by Otis S. Brown and Alfred George = Professor George Woo Otis = Otis S. Brown HAN = HAN Bossino (Alfred) ODs = Majority-Opinion and Minority as listed here Section "a" George: Having read several documents pertaining to Mr. Leung's view on his method of prescribing for myopia, I write to render my opinion. George: Chinese pamphlet on myopia prevention (Appendix 1) George: Mr. Leung's statements and claims are misleading and incorrect. He claims that by wearing convex lenses from 1 to 3 years when someone is developing myopia are not based on evidence. Otis: Direct scientific evidence concerning the dynamic behavior of the fundamental eye? It is obvious that this man totally ignores such evidence. It is clear that at least the objective, scientific facts supports the "second-opinion", even as the "majority opinion" advocates continued ignorance of these objective, scientific facts. This man advocates that the "traditional" minus-lens be continued, and "objection" to its use be completely surpressed. This board has the power to enforce their judgment on Steve Leung George: In the pamphlet, he does not provide any figures for the amounts of myopia when these convex lenses are prescribed. The message is that concave are detrimental to myopia and only convex lenses should be prescribed for myopia. This is contrary to any conventional treatment for myopia. His statements that 90% of myopic patients are receiving the wrong treatment is incorrect and misleading. Otis: This depends on who is "misleading" whom. While I do not expect any OD to put himself at "professional risk" in order to offer a "second opinion", I would at least expect ALL ODs to be sufficiently informed to DISCUSS this alternative with a person -- before that first minus lens is applied. At least the person would have an option to explore more completely the concept of prevention -- and use it effectively if that were his choice. I think all "professionals" have this obligation to offer that discussion. This man judges he has no obligation of that nature. I urge you to continue to offer this choice to a person on the threshold -- with no obligation to go beyond that point. Section "b" George: Note edited by Mr. Leung (Appendix 2) George: Mr. Leung states that the plus is a fogging method. According to him, it is the appropriate method to save one's eyesight. He advocates wearing these convex lenses for distance and near viewing. Constant wearing of these lenses is advocated. Otis: The decision to use the plus "aggressively" must depend on the person's "choice" after he has time to review the issues and the experimental data itself. The actual use of the plus would follow this type of review. Effective use of the plus (for prevention) does require a "strong will", and a certain belief that the method can be successful for the person who is going "all-out" to use the plus correctly. Otis: Again, this depends on the scientific background of the man making the statement. A man who has been saturated with the concept that the eye's refractive status is isolated from its visual environment, is going to make that type of sweeping, un-proven statement -- while totally ignoring a massive amount of direct-experimental data to the contrary. As long as exclusively "ODs" sit on that "board" you (Steve Leung) have no chance of fighting this issue. If the board has some true-scientists, and some people of the "second opinion" concept you (Steve Leung) might stand a better chance. George: He (Steve) also states that for those who have already developed myopia, use of these lenses will stabilize the amount of myopia suggesting that there will be no further increase in myopia. There is no evidence to support his statements. Otis: I would agree that is it very important to begin the use of the plus BEFORE the minus. Once you start with the minus, the natural eye "adapts" to that minus, making recovery (beyond 20/70) almost, or virtually impossible. To goal it to prevent entry in the first place, thus the term "plus-prevention". Section "c" George: Mr. Han's complimentary statements. George: In a table listing his family members' refractive errors. Mr. Han's remarks on them are incomplete and wrong. I assume Mr. Han is a layman an therefore is incapable to describe myopia treatment clearly. However, this information is presumably distributed by M. Leung. HAN: Hey. I wrote those statements by myself. How can you said that my remarks on my family member's are wrong? Do you know my family? Section "d" George: Dr. Stirling Colgate's letter George: I note that Dr. Colgate's letter to the NIH was dated November 8 1977. Young et al's prospective Houston studies were published in 1985 and 1987. Results of the final report by the patient care team are contrary to the belief expressed by Dr. Colgate. Otis: I have every confidence in Stirling's statement of effective prevention when the plus is forcefully used BEFORE the minus lens is used. As the very minimum, it must be recognized that no "perfect proof" can be supplied for any opinion. Otis: Francis Young was only "partially" involved in the Houston study (if at all) and did not agree with the protocol -- nor the results since they contradicted his own results -- which demonstrated that nearsightedness COULD BE PREVENTED on the threshold. This "George" is very selective in what he chooses to report. A "second opinion" board member would be of great value in this review. Section "e" George: Dr. Paul E Romano's letter George: With the E-address provided by Mr. Leung, I tried and failed to access the book prefaced by Dr. Romano. Otis: My book and professor Romano's letter is on the internet. Dr. G. Woo needs to look harder. Section "f" George: It is noted that Dr. Guyton categorically states in his email that "clearly the plus lenses would not be beneficial for distance vision if the individual is already myopic; they are used for near tasks. Mr. Leung, on the other hand, is advocating plus lens for distance and for near use. I cannot agree more with Dr. Guyton's advocacy that Mr. Leung should initiate an actual randomized controlled study, over 3-5 years, to determine the effectiveness of the method he is using. Otis: I advocate that the person himself (pilot) be sufficiently educated so that he be empowered to make both the eye-chart and refractive measurements himself. (i.e., an engineering study at a four year college). Given Francis Young's results, I have no doubt that pilots on the threshold could clear their distant vision from 20/40 to 20/20, with intensive effort with the plus. Since other young men have already done this -- a formalized study -- conducted by engineer-scientists could certainly reproduce this obvious success. The issue will be "who is in control"? If engineers -- I have high confidence in success. If this "George" is in "control" I am certain the effort will "fail" -- for obvious reasons of intense majority-opinion bias. Section "g" George: For your information, Edwards et al of Poly U did conduct a study on the use of progressive lenses (full correction for distance and addition for near). The conclusion -- "The research design used resulted in matched treatment and control groups. There was no evidence that progression of myopia was retarded by wearing progressive addition lens, either in terms of refractive error or axial length" Otis: Even given the fact that the "children" were too young to "follow instructions", Professor Francis Young's study demonstrated that the "plus" group showed a "down" rate of zero diopters (i.e., myopia development effectively stopped over 4 years). When two studies contradict each other, neither one can be "right" and you must look at DIRECT experimental data taken on an "input" versus "output" basis on adolescent primates. This experiment proved what the "bifocal studies" could never prove -- that the natural eye always moves "down" when you place it in a more-confined visual environment or a -3 diopter lens on it. Obviously this majority-opinion professor NEVER wants these scientific facts to see the light of day. Section "h" George: Mr. Leung's letter to Miss Chong George: Mr. Leung cited Dr. Young's statement published in Contacto, a non-citation indexed journal in 1975 to support his belief. Subsequently, Young participated in a prospective Houston study. The final report entitled Houston myopia control study: a randomized clinical trial, Part @. Final report by the patient care team, was published in Am. J of Optometry and Physiological Optics 1987. George: "For the 124 subjects who completed the study, the mean changes in refraction were found to be -0.34 per year for subjects wearing single vision lenses, - 0.36D per year for those wearing +1.00 addition, and - 0.34 per year for wearing +2.00 add bifocal. These differences were not statistically significant." Otis: First of all, Francis Young never participated in the Houston study. I asked him about it, and he did not even have a COPY of the study -- either the staring or ending document. He was not aware that his name was listed on the first document! Otis: As Francis Young pointed out, they used a "small plus" in the lower segment. Very often the young child would avoid looking THROUGH the plus. For this reason the study was not "controlled" in any meaningful scientific sense. Otis: Francis Young's Pullman study used a strong, high-placed plus, where the kid HAD TO LOOK THROUGH THE PLUS. I remember the numbers to be about 240+, where the half wearing the plus showed no "down" movement, were the single-minus when "down" at a steady -1/2 diopter per year. George: It should be noted that the Houston study compared bifocal lens wearing children with single vision lens wearing children with identical amount of myopia. These single vision lenses are concave. They are not convex lenses advocated for distance and near use by Mr. Leung. Otis: At the very minimum, the fact that Dr. Young's study produced a profoundly different result should ALWAYS be discussed. Francis Young did not think much of the "Houston" study for the reasons stated above. Section "i" George: I take exception to Mr. Leung's statements that USA is far ahead of us by 25 years in vision protection for young people. For your information, Poly U's myopia research center was evaluated by a panel of world renowned experts in myopia research two years ago. Otis: Yes, and 92 percent of the medical doctors on Taiwan are myopic. Does this sound like effective "preventive" work. Or blindly following the "traditional" method of the last 400 years -- regardless of consequences, or ignoring the massive amount of DIRECT, SCIENTIFIC data that suggests that the traditional minus lens creates very serious long-term vision problems for all of us. George: I am pleased to inform you that our center ranked 2 in the world. IN the last two international myopia meetings held in HK and Guagzhou in 2002 and Cambridge earlier this year, Poly U's presentations on various aspects of myopia has been significant. Otis: And with all their impressive "expertise" how much myopia have they "prevented"? In fact, 85 percent of Hong Kong high school graduates entering college are myopic. Is this the type of success Dr. Woo is talking about in "successful prevention"? HAN: Spending money to carry research, but in no way to suppress the wide spread of myopia -- Poly U's Center rank 2 in the world, but Hong Kong is the No.1 dense myopic population in the World. Do you not feel SHAME? Section "j" George: Mr. Leung cited scientific studies by three Chinese scholars. No reference, however, was given by him. Indeed, none of his reference cited by him in his letter, is complete. HAN: Dr. Xu Guang Dis, Dr. Jung Yun Xin, Dr. Wang Fang Yun, all of them are most famous eye doctor in China. Maybe George don't read any Chinese ophthalmic books at all. Section "k" George: Mr. Leung in his letter states that "...if the focal adaptation of eye-sight can be caught at the threshold of the situation-focal status is zero or slightly negative (early myopia), then clear distance vision can be maintained/or restored by systematic use of plus lenses" In an article published in Vision Research in 2002, Chung et al proved under-correction of myopia enhances rather inhibits myopia progression thus nullifying Leung's unsubstantiated arguments. Otis: Here again the "George" is selectively reporting what he wants to believe. A person who is "impartial" would have no problem discussing Francis Young's Pullman study. This is a matter of selective bias and preferred ignorance. Section "l" George: It is my professional opinion that Mr. Leung's statements in the leaflet about the treatment of myopia cannot be substantiated. Otis: Fine, I accept that George's statement is the "majority opinion". In no sense should George's statement be allowed to suppress the concept that the natural eye is "dynamic", nor does his statement PROVE that actions should be taken against you to "shut you up -- or shut you down". But we are talking about naked political power of the Board" -- and not about scientific truth as it concerns the dynamic behavior of the fundamental eye. George: His method of prescribing/treatment for myopia is incorrect and inappropriate. His arguments in the various documents are not convincing and they are not evidence based. Otis: The fact that there is a "majority opinion" and "second opinion" means that "arguments and documents" are not "convincing" to EITHER group. That does not mean that either group is wrong. It is just that two contradictory methods must exist side-by-side for some time into the future. Otis: In the long history of medicine (and science) this is about the only method that allows for necessary and fundamental scientific change. Sincerely, Otis Brown